Healthcare Provider Details

I. General information

NPI: 1528604105
Provider Name (Legal Business Name): BRADLEY TAYLOR HATTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 AMHERST ST STE 101
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 210
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-450-0072
  • Fax:
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2458
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: